http://www.sciedu.ca/journal/index.php/crim/issue/feedCase Reports in Internal Medicine2015-03-26T20:07:08-07:00Isabel Graycrim@sciedupress.comOpen Journal Systems<p>Submission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, will not be published elsewhere in the same form, in English or in any other language, without the written consent of the Publisher. The Editors reserve the right to edit or otherwise alter all contributions, but authors will receive proofs for approval before publication.</p> Copyrights for articles published in this journal are retained by the authors, with first publication rights granted to the journal. The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.<img style="float: right; padding-left: 20px; padding-right: 20px;" title="http://www.sciedu.ca/journal/public/site/images/crim" src="/journal/public/site/images/crim/CRIM12.jpg" alt="http://www.sciedu.ca/journal/public/site/images/crim" width="300" height="385" /> <p>Case Reports in Internal Medicine (CRIM) is a peer-reviewed international journal dedicated to promoting scholarly exchange among teachers and researchers in the field of internal medicine. The journal is published semiyearly in both print and online versions by the Sciedu Press.</p><p>Authors are encouraged to submit complete, unpublished, original, and full-length articles that are not under review in any other journals. The online version of the journal is free access and download.</p><p>The journal is striving to achieve high quality through double-blind peer review, as specified in <a href="http://web.sciedu.ca/author-guide.html">Author Guidelines</a>.</p><p><strong>CRIM is included in</strong>:</p><ul><li><span style="font-size: 10px;">EBSCOhost</span></li><li><span style="font-size: 10px;">Google Scholar<br /></span></li><li><span style="font-size: 10px;">ProQuest</span></li><li><span style="font-size: 10px;"><span style="font-size: 10px;">SHERPA/RoMEO</span></span></li></ul><p>The journal is published in both print and online versions. The online version is free access and download.</p><p>To facilitate rapid publication and to minimize administrative costs, the journal accepts <a href="/journal/index.php/crim/about/submissions#onlineSubmissions">Online submission</a> and <a href="mailto:crim@sciedupress.com">Email submission</a>. All manuscripts and any supplementary material can be submitted via the journal’s Online Submission and peer-review system or email to crim@sciedupress.com. For online submission, please create a new account and then follow the instructions given on the screen.</p><p><strong>CRIM’s Sections</strong><br />Case Reports, Case Studies, Reviews.</p>http://www.sciedu.ca/journal/index.php/crim/article/view/5780Two contrasting outcomes of weight loss surgery: Positive impact on the heart, negative impact on the liver2015-03-26T20:07:08-07:00Mohamed F Algahimmalgahim@mcw.eduThomas R. LuxTLux@mchllp.comJoshua G. Leichmanleichman@scvacares.comHeinrich TaegtmeyerHeinrich.taegtmeyer@uth.tmc.edu<p class="a">Bariatric surgery results in significant weight loss in severely obese patients and is associated with beneficial as well as unintended negative consequences. Here we highlight the divergent impact of rapid weight loss in two individuals who underwent bariatric surgery. The first patient is a 58-year-old severely obese [body mass index (BMI) of 48.8 kg/m<sup>2</sup>] Caucasian woman with metabolic syndrome and impaired left ventricular systolic function [preoperative left ventricular ejection fraction (LVEF) 29%]. After undergoing gastric banding, the LVEF improved to 65% at 24 months. This, along with a marked reversal of obesity-related comorbidities following surgery highlight the beneficial impacts that have popularized bariatric surgery. The second patient is a 27-year-old extremely obese (BMI = 81.0 kg/m<sup>2</sup>) Hispanic man without metabolic syndrome and with normal preoperative cardiac and end organ function. One year after undergoing Roux-en-Y gastric bypass, his BMI had decreased to 28 kg/m<sup>2</sup>. The initial weight loss was rapid and paralleled by a loss of lean mass, muscle wasting and the development of cachexia with progressive liver failure and a diagnosis of crytopgenic hepatic cirrhosis.</p> Herein we discuss the cases in detail and provide insight into the divergent impact of rapid weight loss on metabolic homeostasis, the heart, and end organ function. We hope this will aid with the preoperative risk/benefit assessment of severely obese patients being considered for weight loss surgery.2014-12-31T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/6006The electrocardiogram change of conus branch occlusion during right coronary artery angioplasty2015-03-26T20:07:08-07:00Toshiki Kunokuno-toshiki@hotmail.co.jpTaishi Fujisawakuno-toshiki@hotmail.co.jpYohei Numasawakuno-toshiki@hotmail.co.jpToshiyuki Takahashikuno-toshiki@hotmail.co.jp<p class="a">There are few reports of electrocardiogram (ECG) changes of conus branch occlusion. A conus branch artery supply to the outflow tract of right ventricle. A conus branch artery is considered as the substrate of Brugada syndrome. We report a case of conus branch occlusion during angioplasty with ST segment elevation in V<sub>1-3 </sub>like Brugada syndrome ECG. We need to bear in mind that this ECG change may cause lethal arrhythmia.</p>2015-01-14T17:15:06-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/5764“Buddenbrook syndrome” - Toothache and its serious consequences2015-03-26T20:07:08-07:00Ulrike Maria Müllerulrike.mueller@helios-kliniken.deMadlen Uhlemannulrike.mueller@helios-kliniken.deSabrina Wolffulrike.mueller@helios-kliniken.deMarcus Sandriulrike.mueller@helios-kliniken.deGerhard C. Schulerulrike.mueller@helios-kliniken.de<strong>Background: </strong>Atypical symptoms of acute coronary syndrome are associated with increased mortality due to missed diagnosis and treatment delay. Misleading mandible pain as odontogenic instead of cardiac origin may be termed as Buddenbrook syndrome. The name is derived from Thomas Mann’s (1875-1955) novel Buddenbrooks, where one of the main characters, Consul Thomas Buddenbrook, further complained of jaw pain after teeth extraction and died shortly after due to myocardial infarction.<br /><strong>Case Description:</strong> We present a patient with mandible pain, who collapsed at his dentist with the need of prolonged resuscitation due to incessant ventricular fibrillation (VF) caused by acute myocardial infarction. Despite uncertain neurologic prognosis after more than 60 minutes of external cardiopulmonary resuscitation (CPR) and persistent cardiogenic shock 24 hours later we decided to implant an ECMO as the last therapeutic option. The patient improved and could be discharged four weeks later in good neuro- and cardiologic condition. <br /><strong>Clinical Implications:</strong> The primary cardiac cause of mandible or toothache may remain undiscovered if teeth also show a correlate for symptoms and may have adverse outcome. Dentists should think of cardiac origin especially in recurrent symptoms or patients with cardiovascular risk factors.<br /><br />2015-01-14T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/6145Rheumatoid lung sine arthritis – An unusual case mimicking idiopathic pulmonary fibrosis2015-03-26T20:07:08-07:00Chertoff JasonJason.Chertoff@medicine.ufl.eduIslam ElgendyIslam.elgendy@medicine.ufl.eduIbrahim Faruqiibrahim.faruqi@medicine.ufl.edu<p class="a">We present the case of a 72-year-old male, with no history of connective tissue disease or musculoskeletal symptoms, who presented to our pulmonary clinic with five years of worsening dyspnea and presyncope with exertion. Pertinent findings on evaluation were computerized tomography of the chest showing diffuse honeycombing, pulmonary function tests demonstrating an intrinsic restrictive ventilatory defect, labs significant for an elevated C-reactive protein and erythrocyte sedimentation rate, and serologies remarkable for positive rheumatoid factor, positive anti-cyclic citrullinated peptide antibodies, and positive anti-nuclear antibody. Despite never having articular or other systemic manifestations of rheumatoid arthritis (RA), the patient was diagnosed with rheumatoid lung disease, started on definitive therapy and referred to rheumatology. An awareness of this unusual presentation of connective tissue related lung disease is critical to prevent misdiagnosis as idiopathic pulmonary fibrosis, so proper management and optimal patient outcomes are ensured.</p>2015-01-21T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/5674Identifying atypical preeclampsia: A diagnostic challenge2015-03-26T20:07:08-07:00Brittany S Cookbscook1@geisinger.eduMaria C Bermudezbscook1@geisinger.eduAshlee L Smithbscook1@geisinger.eduJames Youngbscook1@geisinger.eduPreeclampsia is a multi-systemic syndrome of variable severity, pregnancy specific, consequence of an abnormal vascular response to placentation, with increase in peripheral vascular resistance and endothelial dysfunction. In the majority of cases, it will present with gestational hypertension and proteinuria, after 20 weeks. Nevertheless, in other cases, it has presented as an atypical form (with absence of hypertension and/or proteinuria) behaving like preeclampsia with severe features. We present a 35 year old G3P2002 at 36 weeks 3 days gestation, with normotensive to mild range blood pressures, absent proteinuria, and acute kidney injury (AKI). We will discuss her management with a trial of furosemide and subsequent delivery based upon the current criteria for diagnosis and management of preeclampsia.2015-01-26T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/6316Esophageal neuroendocrine tumor: A rare finding2015-03-26T20:07:08-07:00Peter Hale Steinpeterhstein@gmail.comStuart Akermanpeterhstein@gmail.comRachel Tannenbaumpeterhstein@gmail.com<p>Neuroendocrine tumors of the esophagus are exceedingly rare, with few cases reported in the literature. Here, we present a patient with a complaint of dysphagia who was found to have this rare finding. Due to the lack of available data, little information exists regarding treatment for this disease. Our patient was successfully treated with combination chemotherapy and radiation with regression of disease on follow-up imaging. We seek to increase awareness of this exceedingly rare but dangerous disease presentation through sharing our unexpected finding.</p>2015-03-01T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/5961Late onset ornithine transcarbamylase deficiency in a 61 year old male2015-03-26T20:07:08-07:00Malfait Malfaitmalfait.thomas@gmail.comGert De Schoenmakeremalfait.thomas@gmail.comFilip Filip Gallantmalfait.thomas@gmail.comHans Hans Schepkensmalfait.thomas@gmail.comAnn Van Loomalfait.thomas@gmail.comWouter Meerssemanmalfait.thomas@gmail.comDavid Cassimanmalfait.thomas@gmail.comSteven Steven Brabantmalfait.thomas@gmail.comJohannes Johannes Häberlemalfait.thomas@gmail.comWim Terrynmalfait.thomas@gmail.comOrnithine transcarbamylase (OTC) deficiency is the most frequent innate urea cycle disorder (UCD) and is the only one with an X-linked inheritance. OTC deficiency leads to hyperammonemia and subsequent elevated cerebral pressure and brain damage. Most often, UCDs are described as acute onset hyperammonemia in the newborn; however, rare, it can present in adulthood. We present the case of a 61-year old Caucasian man with unexplained coma. He developed an acute hyperammonemic encephalopathy leading to mental problems, seizures and coma. Despite the classical treatment with hemodialysis and the administration of a combination of sodium phenylacetate and sodium benzoate, the patient unfortunately died of cerebral herniation. Postmortem, genetic analysis confirmed the presence of a c.662G &gt; A (p.Ala208Thr) pathogenic mutation in the OTC gene in a hemizygous state. Synopsis: The association of neuropsychiatric symptoms or encephalopathy of unknown origin should lead, even in the absence of liver disease and even in late adulthood, to a high level of suspicion of hyperammonemia secondary to UCDs to ensure a timely diagnosis and life-saving treatment. UCD, an inborn error of metabolism, can present itself at an advanced age; attenuated phenotypes probably remain under-ascertained.2015-03-01T00:00:00-08:00http://www.sciedu.ca/journal/index.php/crim/article/view/6207Glibenclamide (glyburide) delay electrocardiographic ST-segment elevation in a diabetic patient with acute myocardial infarction2015-03-26T20:07:08-07:00Ying-Chih Chen990329kmuh@gmail.comPo-Chao Hsupochao.hsu@gmail.comChun-Yuan Chuksmale@gmail.comWen-Hsien Leecooky-kmu@yahoo.com.twHo-Ming Sucobeshm@seed.net.twTsung-Hsien Linlth@kmu.edu.twWen-Chol Voond750078@kmu.edu.twWen-Ter Laiwtlai@cc.kmu.edu.twSheng-Hsiung Sheusheush@cc.kmu.edu.tw<p>Acute myocardial infarction (AMI) is the most frequent cause of death worldwide. The timely diagnosis of AMI, especially ST-segment elevation myocardial infarction, is a key to successful management. A 12-lead electrocardiography (ECG) should be obtained and interpreted as soon as possible. The 12 lead ECG diagnosis may be more difficult in patients without diagnostic ST-segment elevation but with persistent typical ischemic symptoms. Here, we present a diabetic patient with AMI where the ST-segment elevation was masked by glibenclamide (glyburide) initially and delayed ECG change was revealed after glibenclamide was eliminated.</p>2015-03-11T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/5843Superior vena cava syndrome presenting as bilateral breast enlargement with “peau d’orange” skin changes2015-03-26T20:07:08-07:00Gabriela Maloneygabrielamaloney@gmail.comJane Jamesgabrielamaloney@gmail.comBurnetta Herrongabrielamaloney@gmail.comMarylee Branieckimarylee.braniecki@gmail.comA 51 year old female with significant medical history of end stage renal failure presented with bilateral tender breast enlargement, “peau d’orange” skin changes and bilateral axillary lymphadenopathy. The patient was initially diagnosed with mastitis, and underwent a course of antibiotics with minimal improvement. Extensive imaging and repeated biopsies demonstrated benign breast tissue without malignancy. Punch biopsies of breast skin raised a broad differential diagnosis including neoplasm, fibrosing mediastinitis and superior vena cava obstruction. Immediately following the pathology report which included this differential, a superior vena cava (SVC) occlusion with venous stenotic impairment of lateral cephalic outflow was detected. The patient was then treated with resolution of her symptoms. In this case, SVA occlusion was raised based on the patient’s history of chronic renal dialysis requiring multiple catheter placements and by increasing bilateral tender breast enlargement, “peau d’orange” skin changes and histology of lymphedema. We herein describe an unusual case in which the dermatopathologist made the initial awareness of SVA occlusion by seeing lymphangiectasia and stromal edema on a patient with bilateral breast enlargement.2015-03-11T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/6041Serratia marcescens lung abscess with review of a Japanese national inpatient database2015-03-26T20:07:08-07:00Kazuko Miyakawaygoto-tky@umin.netYasushi Gotoygoto-tky@umin.netMitushiro Sunoharaygoto-tky@umin.netHideo Yasunagaygoto-tky@umin.netTakahide Nagaseygoto-tky@umin.netRadiographic examination of an 80-year-old male patient with diabetes mellitus taking prednisolone (30 mg per day) for IgG<sub>4</sub>-related disease (cholangitis and pancreatitis) indicated consolidation within the lung cavity. Repeated bronchoscopies allowed us to diagnose a lung abscess caused by <em>Serratia marcescens</em>. Treatment with cephem antibiotics was effective, and was continued for 3 months. There was no sign of relapse. <em>Serratia marcescens</em> lung abscess is relatively rare, as we found only 14 cases pneumonia of <em>Serratia</em> species in 1.5 million cases of hospitalized patients in national administrative database of Japan.2015-03-18T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/6472Diagnosis and treatment of hemophagocytic lymphohistiocytosis in an adult patient with ehrlichiosis2015-03-26T20:07:08-07:00Joel Provenzanojprovenzano@kumc.eduTimothy Kamerzelltkamerzell@kumc.eduEyad Redaereda@kumc.eduDana Hawkinsondhawkinson@kumc.eduMatthew Sharpemsharpe@kumc.eduHemophagocytic lymphohistiocytosis (HLH) is a rare and often fatal disease, characterized by uninhibited monocyte activation and tissue destruction from an immense inflammatory response. Most cases have been described in the pediatric population, though a rising number of cases have been identified in adults. Adult cases are typically secondary to a triggering process, of which infectious diseases such as Ehrlichia have been implicated. Our patient was an adult male who presented with multi-system organ failure secondary to HLH in the setting of documented Ehrlichia infection, with probable Epstein-Barr Virus (EBV) reactivation. His critical illness resolved after starting appropriate HLH therapy and specific treatment directed at Ehrlichia. This case demonstrates the importance of early recognition and treatment of HLH and its associated triggers in adult patients.2015-03-19T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/5852Aorto-right ventricular fistula: An early complication of aortic valve replacement2015-03-26T20:07:08-07:00Faten Trikitrikifaten@yahoo.frSahar Ben Kahlatrikifaten@yahoo.frRania Hammamitrikifaten@yahoo.frTarek Sellamitrikifaten@yahoo.frAhmed Fkihtrikifaten@yahoo.frDorra Abidtrikifaten@yahoo.frLeila Abidtrikifaten@yahoo.frMourad Hentatitrikifaten@yahoo.frImed Frikhatrikifaten@yahoo.frSamir Kammountrikifaten@yahoo.fr<p class="a">The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.</p>2015-03-25T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/6574Successful surgical decortication for trapped lung in a patient with decompensated cirrhosis2015-03-26T20:07:08-07:00Tripti R. Chopadetriptichopade@gmail.comShe-Yan Wongsheyanwong@gmail.comDavid A. SassDavid.Sass@jefferson.eduScott W. CowanScott.Cowan@jefferson.eduNathaniel R. EvansNathaniel.Evans@jefferson.eduJesse M. Civanjessecivan@yahoo.com<p class="a">Hepatic hydrothorax affects 5% to 10% of patients with cirrhosis. Infection of the pleural fluid may result in “trapped lung” physiology, which may jeopardize a patient’s candidacy for liver transplant, and thus compromise long-term survival. We report a case of a patient with decompensated cirrhosis whose transplant candidacy hinged on management of his trapped lung, and who underwent successful decortication. In this particular case, surgical intervention was necessary not only as a “bridge” to transplant, but also because the patient’s short-term survival was limited by ongoing infection, which was refractory to medical therapy alone. In conclusion, our case illustrates that this high-risk surgery can be successfully carried out in the decompensated cirrhotic, but that further research is needed to ascertain the role for surgical decortication specifically for the purpose of “bridging” a patient to transplant.</p>2015-03-26T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/6021Severe obstructive pattern mimicking an asthma exacerbation as first presentation of crack smoking: A case report2015-03-26T20:07:08-07:00Thomas Galassotommk84@yahoo.itAndrea Mazzettaandrea86.mazzetta@libero.itValentina Coniovalentina.conio@libero.itElena Paracchinielena.paracchini@gmail.comSara Surbonesurbsara@alice.itEti Maria Giulia Di Vincenzogiuliadivincenzo@gmail.comIsa Cerverii.cerveri@smatteo.pv.itFederica Melonitommk84@yahoo.it<p>Crack inhalation is known to cause a wide spectrum of acute and chronic pulmonary complications, along with imaging manifestations and lung function patterns. The diagnosis of these conditions is often delayed or mistaken. Only little information about the management and follow up of these pulmonary complications is available in literature. We present the case of a young patient referred to our clinic for symptoms mimicking an asthma exacerbation, not responsive to inhalant treatment. After investigations and the admission of crack abuse by the patient a final diagnosis of bronchiolitis crack-related was made. The patient was then followed for more than a year showing that lung function tests may be useful both for the diagnosis and follow up of such pulmonary complications.</p>2015-03-26T00:00:00-07:00http://www.sciedu.ca/journal/index.php/crim/article/view/6330Farmer’s lung with a high CD4/CD8 ratio lymphocytic alveolitis: A case report2015-03-26T20:07:08-07:00David Badovinacbadovinac.david@gmail.comBarbara Salobirbarbara.salobir.pulmo@kclj.siMarjeta Terčeljmarjeta.tercelj@kclj.si<p class="a"><strong>Background:</strong> Farmer’s lung is one of the most common forms of hypersensitivity pneumonitis (HP). It is a granulomatous inflammatory disease of the pulmonary parenchyma caused by the immune response to inhalatory antigens, mostly actinomycetes or moulds. The diagnostics range from imaging techniques to bronchoalveolar lavage, which demonstrates a typical lymphocytic alveolitis with a low CD4/CD8 ratio in only one third of patients. It is hypothesised that a low CD4/CD8 ratio predicts a prosperous course of the disease, but a high CD4/CD8 ratio lymphocytic alveolitis has yet to be determined to announce a more severe clinical course.</p> <p class="a"><strong>Case report:</strong> This case report presents a patient with farmer’s lung, with a high CD4/CD8 ratio lymphocytic alveolitis and the dynamics of her disease in relation to her environment and therapy. There was clinical improvement, even without therapy, each time the patient moved away from the risk home environment and a setback when she returned back home. Eventually, lung fibrosis with pulmonary hypertension developed.</p> <strong>Conclusion:</strong> Our case report does not only illustrate a clear etiological correlation between exposure to causative antigens and progression of farmer's lung, but also emphasises the necessity of early recognition and thorough sanitation of patients’ living space. Furthermore, a high CD4/CD8 ratio lymphocytic alveolitis, which is not typical for HP, is indicative of a continuous exposure to causative agents, leading to chronical inflammation and thus a worse clinical course of the disease.2015-03-26T00:00:00-07:00